Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Vice President, Regulatory Compliance

📁
Vice President
📅
190ET Requisition #
Sign Up for Job Alerts

Oversees the strategy, design, development, implementation, and evaluation of the EmblemHealth Regulatory Compliance Program that identifies and monitors compliance with Federal and State laws including, but not limited to Medicare Advantage, Medicare Part D, Medicare Special Needs Plans, Medicaid, Medicaid Advantage, and Commercial lines of business (i.e., Essential Plan, Child Health Plus, Medicare Supplement, Health Insurance Exchange products). Presents to the Board of Directors and the Combined Corporate Compliance Committee of the Board of Directors as needed and upon request. Expand the Regulatory Compliance program to include all government programs such as Medicare Advantage, Medicare Part D, Medicare Advantage Special Needs Plans, Medicaid, Medicaid Advantage, CHIP, MLTC, FIDA, and Commercial lines of business, such as the Essential Plan, Medicare Supplement and health insurance exchange products. Maintains a working knowledge of relevant issues, laws and regulations affecting the organization and industry.  Works with various outside external entities including, DFS, DOI, DOH, AHIP, and Attorney General on behalf of the enterprise. Plans and performs a comprehensive mock audit program, including an annual Medicare Compliance Program Assessment or other special projects that assist the organization with accomplishing its objectives by evaluating and improving the effectiveness of internal control process(es). Oversees and coordinates of all external audits with the Centers for Medicare and Medicaid Services, Human and Health Services, Office of the Inspector General, and the Department of Health.  Collaborates with state Medicaid programs, Medicaid Fraud Control Units, commercial payers, and other organizations when a fraud, waste or abuse issue is discovered to involve multiple parties. Oversees the organization’s Delegate Oversight and Vendor Management programs, including administration of the Delegate Oversight Committee, management of annual delegate audits, facilitation and confirmation of delegate corrective action preparation and implementation, monitoring vendor data reporting, and facilitating vendor corrective action plan preparation and implementation. Directs the identification and evaluation of Enterprise-wide regulatory risk areas through an annual risk assessment process and the development of the annual Compliance Auditing and Monitoring Plan. Responsible for the risk management issues that directly impact the strategic direction of the organization.  Charged with delivering the strategy to the company by identifying, evaluating, mitigating and monitoring various risk factors. Reports to Senior Management to advise on all potential risk and exposure to the Plan.


Responsibilities:

  • Makes significant contributions towards EmblemHealth’s short and long-term business initiatives which include Operating Income, Administrative Expenses, Medicare & Medicaid ratings, and Net Promoter Score performance-Identifies, hires, & trains staff members, developing them into strong leaders and creating high-performing, self-directed teams.  Effectively plans for succession planning ensuring talent pipeline.
  • Acts as change agent to drive and effect organizational change ensuring key deliverables are met.

Qualifications:

  • Master’s Degree in Healthcare administration, Business, or Related Field) or other Advanced Degrees (Juris Doctor, Medical Doctor)

  • 15+ years of relevant experience

  • Experience working in or with CMS and other government regulatory agencies

  • Certification in Healthcare Compliance preferred

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

Previous Job Searches

Similar Listings

New York, New York

📁 Vice President

New York, New York

📁 Vice President